Dental bridge pain persists.

Nine days of pain after a new bridge and recent root-canal treatment deserves a careful re-evaluation, but a normal OPG and a good-looking RCT do not automatically mean the tooth must be extracted. Pl refer my point wise reply against your query 1. Your pain can have several causes Healing/inflammation around the root after RCT. Bite/occlusal pressure, even if the high point has already been adjusted. Inflammation of the ligament around the tooth. A crack or fracture that may not be visible on a routine OPG. Less commonly, a missed canal or persistent infection. sensitivity after dental treatment can sometimes settle over 2–4 weeks, but persistent or worsening pain should be reassessed. 2. I would get an endodontist's examination before considering extraction. Ask the endodontist to specifically check: Pain on biting and on releasing the bite Percussion and palpation Detailed periodontal probing around the tooth Tooth mobility Bite/occlusion Adjacent teeth to make sure the pain isn't coming from another tooth The quality and length of the RCT Periapical dental X-rays from different angles Transillumination/magnification for a possible crack CBCT only if clinically indicated A cracked tooth can produce intermittent chewing/temperature pain and may be difficult to identify on ordinary X-rays. Is extraction necessary? Not at this stage based only on the information shown. If examination finds a vertical root fracture extending below the gum/bone, or a crack that makes the tooth non-restorable, extraction may ultimately be necessary. But if the tooth is structurally sound and the RCT is adequate, other treatment options may exist. Temporary pain relief If the patient is an adult and has no stomach ulcer/bleeding, kidney disease, NSAID allergy, blood-thinner use, or other contraindication: Option 1: Ibuprofen 400 mg after food when required. If pain is stronger: ibuprofen 400 mg + paracetamol 500 mg can be used together when appropriate. NSAIDs such as ibuprofen, alone or with paracetamol, are recommended first-line options for acute dental pain. Do not exceed the recommended doses on the package/prescription, and avoid taking multiple medicines containing paracetamol simultaneously. Antibiotic? Don't start an antibiotic just because the tooth hurts. Antibiotics usually aren't helpful for pain alone. They are generally considered when there is infection with findings such as swelling and/or systemic symptoms such as fever or malaise. Definitive dental treatment is more important.

As you already had two occlusal adjustments and a second opinion, I would get one consultation with an experienced endodontist before agreeing to extraction. Do not rush into extraction solely because the OPG is normal but the pain continues. At the same time, don't ignore persistent pain—identify the exact source first.

If there is facial swelling, fever, pus, rapidly increasing swelling, difficulty swallowing, or difficulty breathing, the patient should seek urgent dental/medical care.

Hello, I understand your concern but I would like to request you to notice exactly, to be specific ..... 1.where are you experiencing the pain  i .e sensitivity exactly in which region of the bridge i.e front ,middle or end part of the bridge ? 2.you have morning pain after waking up in the same region but what is the nature of the pain i.e continuous, sharp, intermittent,or spontaneous ? 3.also ,do you have difficulty in chewing food like hot or cold both .Also with sweet or sour, Please notice it. 4.what medication are you are taking?

let me know so that I can guide you.

don't panic

Hi! As it is a 2d picture we can’t evaluate 3d picture of tooth, we can go for Iopa or xray at different angulations to evaluate any non negotiable canal if there if you don’t want to go for CBCT. Sensitivity to cold and hot only persist if remanant of any nerve or pulp tissue left. For second premolar it is not mandatory to go for ROOT Canal before placing crown until unless Rct not indicated. If pain persist go for atruamatic removal of bridge by expert dentist followed by Re-rct of Second molar from a endodontist only.

Hlo mam…as i can see from the x ray…..there is fracture of crown portion of molar but that is not the reason for your pain and sensitivity. The main reason is your premolar as on premolar crown has been placed without doing rct and that is causing all the problem as if we go for crown placement without rct then that often cause problems in near future. As u r having missing tooth on your right side and one rct treated tooth also so it is possible that u r only chewing from your left side and that is putting pressure on the left side teeth. Anyway if a bridge is placed there is sensitivity and a feelig of pressure while chewing and all for few days.

Go to the dentist and get the premolar checked properly and get the treatment done accordingly.

Till then avoid putting too much pressure on the left side teeth and also try to chew from the right side teeth.

Avoid having heavy chewing forces on that tooth for 3-4 days more, check for periodontal pockets Such a case can be best known and treated by cbct analysis

Hi Did you have any pain after RCT and before placement of bridge? Sensitivity after RCT might be coz of incomplete rct or missed canal too. If high points are adjusted then you need to get the bridge removed and get your tooth evaluated.

Get other side crowns and implants done.. Single side chewing will increase your problems more

Sensitivity can last for a few more days post treatment. But if you require medicine to manage the pain then i would suggest to visit the same dentist again so that she can check if the bite is correct or not.

Pain or tenderness can sometimes persist for a few days to a couple of weeks after RCT and placement/replacement of a bridge, particularly if the tissues around the root are still inflamed or the tooth has been subjected to excessive biting forces. The fact that the pain is worse on waking can also sometimes be associated with clenching/grinding or increased occlusal load. The OPG shown does not, by itself, establish that the tooth needs extraction. Also, a crack or root fracture cannot always be detected on a routine X-ray, so your concern is understandable.

Since the pain is still present 9 days after treatment, I would recommend a review with the treating dentist or preferably an endodontist. The tooth should be clinically evaluated for: * Percussion and palpation tenderness * Occlusion/high contact, even after previous adjustments * Periodontal probing around the tooth * Symptoms on biting/release * RCT quality and possible missed anatomy * Signs of crack/root fracture A small periapical radiograph with appropriate angulation is generally more useful for assessing the treated tooth than relying only on an OPG. If the clinical findings remain inconclusive, the dentist may consider CBCT selectively. I would not advise extraction solely because the pain is persisting at 9 days, particularly when two dentists have said that the RCT appears satisfactory. The cause should first be identified.

For now, avoid chewing hard foods on that side and avoid repeatedly testing the tooth by biting on it. If there is increasing pain, swelling, fever, pus, or difficulty opening the mouth/swallowing, seek dental care promptly. And importantly, having one or more molars extracted does not mean that you will inevitably lose all your lower molars. Each tooth should be assessed individually, and a tooth with a satisfactory RCT can often be retained if the underlying problem is treatable.

The root canal looks fine. And there are no visible reasons of pain. U can take cbct. Or extract the tooth as your dentist suggest. Also u can opt for implants for the missing molars in your lower jaw.

Ask about immediate implants from your dentist.

Hello The RCT looks good Please visit the dentist to evaluate